Saturday, December 8, 2012

Small Fiber Neuropathy Found in Fibromyalgia; Gulf War Veterans Sought for Similar Study

New fibromyalgia research findings, described in the online article below, show small fiber neuropathy in a majority of fibromyalgia patients with neuropathic pain.

Fibromyalgia, a condition characterized by chronic widespread pain, as well as fatigue, and other symptoms, is a presumptive condition for VA service-connection for veterans who served in the Southwest Asia theater of operations since August 2, 1990.

Symptoms of small fiber neuropathy (or, Small Fiber Peripheral Neuropathy, or Small Fiber Polyneuropathy) are typically in the feet, lower legs, or hands, and can include buzzing, tingling, pain, burning, feeling hot, and redness.  One medical research article cleverly described small fiber neuropathy as, "a burning problem."   

A similar medical research study by Dr. Louise Oaklander in Boston, funded by the treatment-focused Gulf War Illness Congressionally Directed Medical Research Program (CDMRP), is checking for small fiber neuropathy in 1991 Gulf War veterans through a small skin biopsy.  This study is still actively recruiting study subjects.  If you're a veteran of the 1991 Gulf War, and you are suffering from Gulf War Illness issues or are healthy, you're urgently needed.  

Dr. Oaklander's study also examines measures of autonomic nervous system functioning, which has been suggested by Dr. Robert Haley's research finding to be involved in Gulf War Illness for at least some ill Gulf War veterans.  

Other Gulf War Illness research, including by Dr. Nancy Klimas in a study conducted at the Miami VA Medical Center, has found apparent differences between fibromyalgia and GWI.  The results of Dr. Oaklander's CDMRP-funded study will be important to help determine whether, as in Fibroymyalgia, small fiber neuropathy may be an issue among Gulf War veterans with GWI.  

Of potential interest to Gulf War veteran readers and their caregivers, I posted an article back in January 2010 about new testing available to diagnosed SFPN.  (See article here)   Small fiber neuropathy is generally undetectable by common neurology testing.  


Gulf War Illness Small Fiber Polyneuropathy Study (Boston)


Click on this link to find out about Massachusetts General Hospital's Gulf War Illness Study:
 (Please note: This Adobe Acrobat .pdf file may take a while to download.)


Source: Helio

Small fiber neuropathy detected among patients with fibromyalgia

  • December 6, 2012
WASHINGTON — A majority of patients with fibromyalgia and neuropathic pain were diagnosed with small fiber neuropathy based on reduced epidermal nerve fiber, according to research presented at the American College of Rheumatology Annual Meeting.
Researchers retrospectively examined 56 patients who met either the ACR criteria or the 2010 revised fibromyalgia criteria. Punch biopsies were performed at proximal and distal sites on patients’ lower limbs. Epidermal nerve fiber density was counted on 50 micron sections, and PGP 9.5 immunolabeling was performed.
“A significant percentage of patients with fibromyalgia will often have neuropathic complaints, so in addition to the kind of dull muscle, flu-like symptoms, they will get burning, stabbing, tingling [and] allodynia,” researcher Todd D. Levine, MD, assistant professor at the University of Arizona, told “Some of them will have autonomic systems. All of that is suggestive that there might be a neuropathic component to their disorder.
“Despite that, if you do traditional EMG/nerve conduction studies, those are normal. One of the reasons we think that it is normal is that the pain fibers … are very small fibers. They’re too small to be detected by the standard tests. So, this technique, which involves a small 3-mm punch biopsy, allows us to study these small unmyelinated nerve fibers in patients.”
A standard serologic evaluation searched for identifiable causes for neuropathy in patients with reduced epidermal nerve fiber density, resulting in 61% of patients being diagnosed with small fiber neuropathy. Five patients displayed evidence of neuropathy on EMG/nerve conduction studies that was inconclusive for diagnosis.
Of the patients with fibromyalgia and small fiber neuropathy, 71% had serologic evidence of underlying etiology for the neuropathy, which had been undetected previously and most of which was treatable. Identifiable causes of small fiber neuropathy among patients included glucose metabolism (n=11), vitamin D deficiency (n=5), Sjögren’s syndrome (n=2) and elevated erythrocyte sedimentation rate (n=2).
“This would argue that at least in some of the patients, the pain generator may be the small nerves, as opposed to being in the brain, where some people think the pain is,” Levine said. “Probably it’s going to be a combination of both, so that fibromyalgia is really, probably a combination of pathophysiologies.”
Disclosure: Levine and researcher David Saperstein, MD, reported ownership or partnership in Corinthian Reference Labs.
For more information:
Levine TD. P969: Presence of Small Fiber Neuropathy in a Cohort of Patients with Fibromyalgia. Presented at: American College of Rheumatology 2012 Annual Meeting; Nov. 10-14, Washington.

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